Palm Side Wrist Pain From Gaming

Expert Opinion

• One of the most commonly reported pain patterns in gaming is palm-side wrist pain.
• One of the most commonly injured areas in gaming due to the stress and strain put on the finger flexors.
• Creative Warrior Tendinopathy is irritation of two tendons that cross the wrist and lead to the tips of the fingers.
• These muscles/tendons are responsible for gripping and clicking the mouse or hitting various keys on a keyboard.

What Does This Diagnosis Mean

Creative warrior tendinopathy is a condition that affects two muscles/tendons in your forearm, wrist, and fingers. Tendons are like little ropes that connect your muscles to your bones, and they help you move specific joints. When you play video games or use your wrist and fingers a lot, these tendons can get irritated and swollen, causing pain. These tendons in particular allow each person to bend their fingers and click/push buttons.

This diagnosis is termed "Creative Warrior Tendinopathy" due to the frequent occurrence in Fortnite gamers. In Fortnite, gamers are often switching between weapons or making/editing builds in a very rapid manner. This leads to extremely high APMs (Actions Per Minute) which can lead to overuse of the finger flexor muscles/tendons. This name is also interchangeable with Flexor digitorum superficialis/flexor digitorum profundus (FDS/FDP) tendinopathy. This diagnosis is vastly different from carpal tunnel syndrome as carpal tunnel from gaming is much less common than many believe.

Common Things You Might Feel

Gamers are likely to begin experiencing pain and discomfort while playing and a sore, achy, or stiff feeling after, in the area indicated above. Weakness is also likely to be present with gripping and moving the mouse. This is likely to decrease performance and alter the gameplay of the individual. Pain will be worse with any gripping or pinching required throughout the day such as shaking up a protein shake, pulling a laptop/books out of a backpack, or gripping a dumbbell.

Disclaimer: The following information is provided for general educational purposes only and should not be considered medical advice. It is not intended to replace consultation with a qualified healthcare professional. If you have specific concerns or questions about your health or medical condition, please seek the guidance of a licensed physician or another qualified medical practitioner. Any reliance you place on the information provided is solely at your own risk. In no event will the author or 1HP be liable for any loss or damage arising from using this information. Always consult with a healthcare professional before starting or changing any medical treatment or regimen.

How Does It Happen to Gamers?

Gamers use their fingers a lot! Gamers are at risk because of the long durations we play and reduced rest breaks. Computer gamers in particular are at an increased risk compared to mobile and console gamers due to the nature of the games and the speed/force they need to push/click buttons. Each time the mouse is clicked, these muscles/tendons are being used. It is less about the amount that they are clicked, but more about the force gamers are putting into each button click. The greater the speed and force, the greater the muscle stress and activation (Yoo, 2015).

How to Fix It / Recover / What Can You Do?

1. Identify the issue (early detection…do NOT push into or through pain).
2. Rest the wrist/fingers (a few days reducing workload, but continue moving the wrist, fingers, elbow).
   • Splinting: Used minimally; rarely recommended as it is relatively restrictive, but if necessary look for a "resting hand splint."
3. Massage in times of pain/discomfort.
4. Utilize heat/ice (hot/cold packs, warm water soak). Be cautious using ice over nerves.
5. Initiate isometric exercises — a good starting exercise to regain/maintain strength while limiting pain.
6. Stretching — helpful throughout the range of motion.
7. Isotonic strengthening — improve strength and endurance to decrease pain and prevent recurrence.

Additional tip: Consider utilizing lifting hooks to decrease the muscle recruitment necessary for pulling or gripping movements while lifting (deadlifts, rows, bicep curls, lat pulldowns). Use only when pain is present (not an endorsement of IronBull Strength).

Surgery is very rarely required in order to effectively treat.

For a comprehensive guide on the exercises discussed, check out the videos on our Fix Wrist Pain page.

Science Behind The Injury

Specifically, this diagnosis is looking at two tendons (connecting muscle to bone) responsible for bending (flexing) the fingers. These tendons can feel irritated at various points such as the wrist crease as they run from near the elbow into the tips of the fingers.

Tendons responsible:

• Flexor Digitorum Superficialis — Primary flexor of the proximal interphalangeal (PIP) joints of the middle phalanges of all fingers aside from the thumb (digits 2–5) while assisting flexion of the metacarpophalangeal (MCP) joints. Originates at the medial epicondyle and shaft of the radius; attaches to the volar aspect of the middle phalanx of digits 2–5.
• Flexor Digitorum Profundus — The only flexor of the distal interphalangeal (DIP) joints of digits 2–5 while assisting flexion of MCP and PIP joints. Originates at the shaft of the ulna and interosseous membrane; attaches to the volar aspect of the distal phalanx of digits 2–5.

Both muscles also help with bending the wrist towards the palm (wrist flexion). This injury can also be common in climbers.

Differential Diagnosis

• Ganglion Cyst — A fluid-filled sac that grows from the lining of our joints; often needs to be removed (seek medical advice).
• Wrist Instability — Anatomical variations in bone length/alignment or injury can lead to increased strain on supporting structures (ligaments/tendons), resulting in pain and decreased performance.

Preventative Approach

There are 3 main factors to first focus on, plus secondary factors.

1. Strengthening exercises — Build a foundational base for the tendon/muscle.
2. Intermittent stretching (during and after gaming sessions).
3. Proper warm-up — Promotes blood flow and lubricates stiff joints.

Additional: Ergonomics/positioning; rest breaks (every 45–60 minutes); massage; ice; heat; relative rest; Sleep/Nutrition/Mental health.

References

• Yoo W. G. (2015). Effects of different computer typing speeds on acceleration and peak contact pressure of the fingertips during computer typing. Journal of physical therapy science, 27(1), 57–58.